ICU team takes ventilator-associated pneumonia down to zero

When Joseph Nates, M.D., joined MD Anderson’s faculty in 2002, he
discovered a high incidence of ventilator-associated pneumonia.

BY Lauren Schoenemann

By 2009, he and his team had brought its occurrence to zero.

In the Intensive Care Unit (ICU), 90% of pneumonias occur while patients are ventilated. Ventilator-associated pneumonia (VAP) increases the length of hospitalization by an average of 23 days, with an associated cost per patient of approximately $150,000. In the United States, the mortality rate attributed to this complication is estimated to be as high as 30%, the greatest among all health care-associated infections.

Nearly 10 years ago, MD Anderson’s ICU VAP rate was 34.2 cases per 1,000 ventilator days in the Surgical Intensive Care Unit, equivalent to more than 10 cases per month — double the national average for trauma ICUs.

“Using the most conservative estimate, two of every 10 patients with VAP could die from this complication,” says Nates, professor in the Department of Critical Care and medical director of the ICU. “Preventing these cases could save the lives of 24 patients in the ICU each year. The problem needed to be addressed urgently.”

Distinguished by diligence

Nates and a multidisciplinary team that included physicians, nurses, infection control officers, respiratory therapists, physiotherapists and pharmacists worked to eradicate VAP through multiple stages. They incorporated guidelines from the Institute of Healthcare Improvement, the Centers for Disease Control and the Agency for Healthcare Research and Quality.

Nates estimates that the significant reduction in the incidence of VAP has saved the lives of at least two patients per month. It has also reduced the time spent in the ICU and saved the health care system about $600,000 per month.

This accomplishment has not gone unnoticed. In October 2010, Nates received a Clinical Safety and Effectiveness Award from The University of Texas System, and, in February 2011, the inaugural Bill Aston Award for Quality from the Texas Hospital Association honored MD Anderson for the achievement.

The team is now investigating new technologies that could completely prevent aspiration (inhaling fluid or other foreign matter into the lungs), which is the main cause of VAP.

“We cannot remain static,” Nates says. “One of our most important success factors has been remaining alert while adapting practices in synchrony with new discoveries.”

Did you know? — Many of the techniques Nates and his group used to bring ventilator-associated pneumonia down to zero in the Intensive Care Unit had not been published when they started to address the situation in 2002. They continue to learn and work on the problem. “We haven’t eliminated the causes,” he says. “If we don’t continue to work on the factors that lead to VAP, the infections will come back.”

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